NursingPlus Open 2 (2016) 8–14

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NursingPlus Open
journal homepage: www.elsevier.com/locate/npls

Research article

How to plan and perform a qualitative study using content analysis

Mariette Bengtsson
Faculty of Health and Society, Department of Care Science, Malmö University, SE 20506 Malmö, Sweden

art ic l e i nf o a b s t r a c t

Article history: This paper describes the research process – from planning to presentation, with the emphasis on
Received 15 September 2015 credibility throughout the whole process – when the methodology of qualitative content analysis is
Received in revised form chosen in a qualitative study. The groundwork for the credibility initiates when the planning of the study
24 January 2016
begins. External and internal resources have to be identified, and the researcher must consider his or her
Accepted 29 January 2016
experience of the phenomenon to be studied in order to minimize any bias of his/her own influence. The
purpose of content analysis is to organize and elicit meaning from the data collected and to draw realistic
Keywords: conclusions from it. The researcher must choose whether the analysis should be of a broad surface
Content analysis structure (a manifest analysis) or of a deep structure (a latent analysis). Four distinct main stages are
Credibility
described in this paper: the decontextualisation, the recontextualisation, the categorization, and the
Qualitative design
compilation. This description of qualitative content analysis offers one approach that shows how the
Research process
general principles of the method can be used.
& 2016 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction circumstances in order to detect and take into account mis-

Qualitative research contributes to an understanding of the
human condition in different contexts and of a perceived situation.
However, there is no perfect designed study, and unexpected
events will always appear. The main issue is how much financial
resources, time and effort the researchers in a study team are able
to invest in trying to understand the phenomena under study
(Patton, 2002). Nevertheless, a researcher has to create the best
study design possible, through accurate and considerate planning
based on existing circumstances by identifying available resources.
Firstly, there is the mapping of external resources – such as eco-
nomics, time and potential informants – because some methods
for data collection and data analysis are cost and time-consuming,
and the choices of methods must be adapted to such restrictions.
Second, internal resources of the study team, such as knowledge
and ability, have to be known. The researcher's self-reflection is an
essential part of qualitative research whatever chosen qualitative
method (Burnard, 1995). The researcher must take into con-
sideration his or her “pre-understanding”, both in the planning
process as well as during the analyzing process, in order to
minimize any bias of his/her own influence (Elo et al., 2014; Long
& Johnson, 2000). To have preconceived knowledge of the subject
and to be familiar with the context can be an advantage as long as
it does not affect the informants or the interpretation of the
results. The researcher needs to understand both the context and
E-mail address: mariette.bengtsson@mah.se
representations that may crop up in the data (Catanzaro, 1988). All
qualitative research deals with some interpretation. However, the
interpretations vary in depth and level of abstraction, depending
on the method of analysis and on the researcher's ability to dis-
tance him/herself (Patton, 2002; Silverman, 2001). When limits of
the study are identified and discussed, the actual planning of the
study then begins. An important factor to bear in mind during
both the planning and the application is to maintain as high a
degree of quality as possible throughout the whole process.
In qualitative research, several analysis methods can be used,
for example, phenomenology, hermeneutics, grounded theory,
ethnography, phenomenographic and content analysis (Burnard,
1995). In contrast to qualitive research methods, qualitative con-
tent analysis is not linked to any particular science, and there are
fewer rules to follow. Therefore, the risk of confusion in matters
concerning philosophical concepts and discussions is reduced.
During the entire process, the researcher must adhere to a quali-
tative perspective, and the main issue is to achieve the rigor and
credibility that make the results as trustworthy as possible.
However, in content analysis, different concepts of credibility can
be chosen in the discussion of trustworthiness. It is possible for
the researcher to use the same concepts as in quantitative studies,
an option that is not accepted when performing analysis using
other qualitative methods (Long & Johnson, 2000).
No matter what chosen method, the process of analysis reduces
the volume of text collected, identifies and groups categories
together and seeks some understanding of it. In some way, the
researcher attempts to “stay true” to the text and to achieve

http://dx.doi.org/10.1016/j.npls.2016.01.001
2352-9008/& 2016 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 M. Bengtsson / NursingPlus Open 2 (2016) 8–14 9

trustworthiness (Downe-Wambolt, 1992; Morse & Richards, 2002; (p. 18). Downe-Wambolt (1992) underlines that content analysis is
Patton, 2002; Silverman, 2001). This article focuses on content more than a counting process, as the goal is to link the results to
analysis and on several definitions and descriptions of content their context or to the environment in which they were produced:
analysis as a quantitative and/or qualitative method that have been “Content analysis is a research method that provides a systematic and
presented over the years. In 1952, Berelson defined content analysis objective means to make valid inferences from verbal, visual, or written
as “a research technique for the objective, systematic and quantitative data in order to describe and quantify specific phenomena” (p. 314).
description of the manifest content of communication” (p. 18). By An overview of the research process from planning to pre-
using the concepts technique and objective, Berelson underlines the sentation can be seen in Fig. 1.
process of analysis as a reliable and learnable method that pre-
cludes the personal authority of the researcher. However, Berelson's
definition does not capture the qualitative and latent perspective of The planning
the analysis. In order to make the method applicable both in a
quantitative and a qualitative approach, and without specifying the In all research, it is essential to begin by clarifying what the
depth of analysis, Krippendorff (2004) defined content analysis researcher wants to find out, from whom and how. The purpose
as “a research technique for making replicable and valid inferences may be of a descriptive or exploratory nature based on inductive or
from texts (or other meaningful matter) to the contexts of their use ” deductive reasoning. Inductive reasoning is the process of
THE IMPACT ON THE QUALITY OF THE STUDY

PLANNING
Which external and internal resources

AIM
Is there an interesting problem taped in sizeto be elucidated?
SAMPLE AND UNIT OF ANALYSIS
are available?

Who can best answer the queries set out in the aim?
METHOD OF DATA COLLECTION
How should the information from the informants be collected?
METHOD OF ANALYSIS
How should the collected data be analyzed?
PRACTICAL IMPLIKATION
Do we need someone’s approval?

DATA COLLECTION
By written or verbal questions, or by observations, and transform the
collected data into a written text
.

DATA ANALYSING

Manifest analysis Latent analysis

Surface structure Deep structure
“What has been said?” “What intended to been said?”

Stage 1. Decontextualisation
Identify meaning units
Create code list, repeat and start at new pages
,
Coding system Coding system
Inductive or deductive Inductive or deductive

Stage 2. Recontextualisation
Include “content”- exclude “dross”
Distance
Compare Compare
with the original data with the original data

Stage 3. Categorisation
Identify homogeneous groups
Triangulation by investigators

Condense meaning units

Bring subjects together Bring subjects together

Stage 4. Compilation
Draw realistic conclusions
Member check, colleagues, inquiry audit
Use the words themselves Find the underlying
stay close to the text meaning of the text

CREATING A REPORT AND PRESENTATION OF THE RESULT

Fig. 1. An overview of the process of a qualitative content analysis from planning to presentation.
10 M. Bengtsson / NursingPlus Open 2 (2016) 8–14
developing conclusions from collected data by weaving together
new information into theories. The researcher analyses the text
with an open mind in order to identify meaningful subjects
answering the research question. Deductive reasoning is the
opposite. Here, the researcher looks for predetermined, existing
subjects by testing hypotheses or principles (Berg, 2001; Cat-
anzaro, 1988; Polit & Beck, 2006). When a study has been initiated,
the study design has to be established. Moreover, five main issues
must be considered in the planning process: the aim, the sample
and unit of analysis, the choice of data collection method, the choice
of analysis method and the practical implications. The researcher has
to consider these five issues repeatedly before starting the data
collection in order to anticipate unexpected events. To ensure
credibility, there must be a chain of logic between the decisions
made and how the study will be conducted. In order to recapitu-
late and report the development of the process, the researcher
should write memos during this process (Morse & Richards, 2002).
The aim
The planning discussion begins by establishing the aim, which
determines the structure of the study design and sets its
boundaries (Downe-Wambolt, 1992). It is important to identify
an interesting and unexplored dilemma, and then present it in a
concise form. If the aim of the investigation is too broad, the risk
of touching upon too many aspects may preclude the researcher
reaching the desired depth of the studied phenomenon (Silver-
man, 2001). Even if the researcher can handle a large amount of
data in a content analysis, difficulties do arise when the purpose
is too broad.
The sample and units of analysis
In qualitative studies, it is common that data are based on 1 to
30 informants (Fridlund & Hildingh, 2000). However, the sample
size should be determined on the basis of informational needs so
that the research question can be answered with sufficient con-
fidence (Krippendorff, 2004; Patton, 2002). The concept unit of
analysis refers to the sample, and the researcher has to determine
whether the material is to be analyzed in its entirety or divided
into smaller units. The researcher has, for example, to decide
whether data collected from women and men or data collected at
different times in a person's life should be analyzed separately or
not. In this decision, the researcher is guided by the aim to be
achieved, and each unit of analysis implies a different focus for the
study. The key issue in making this decision is to decide what the
researcher is seeking to elucidate by the study (Patton, 2002).
There are no established criteria when using content analysis for
the size of a unit of analysis, neither the number of informants or
objects to study, nor the number of pages based on the informants'
own written text or transcribed data.
The choice of data collection method
Content analysis can be used on all types of written texts no
matter where the material comes from. Moreover, there are no
specific rules that must be followed (Berg, 2001; Burnard, 1991;
Catanzaro, 1988; Downe-Wambolt, 1992), for example, deep inter-
views (Wann-Hansson, Hallberg, Klevsgård & Andersson, 2005),
focus group interviews (Golsäter, Sidenvall, Lingfors & Enskär, 2011),
one single written question (Bengtsson, Ohlsson & Ulander, 2007),
open-ended questions as in a questionnaire (Donath, Winkler,
Graessel, & Luttenberger, 2011), or observations of situations (East-
wood, O'Connell & Considine, 2011) as well as from pictures and
films (Krippendorff, 2004; Neuendorf, 2002). However, the choice of
data collection method affects the depth of the analysis. For example,
open-ended, written questions cannot provide the same depth that
an interview can provide, as the researcher has the opportunity to
deepen the discussion with the informants.
The choice of analysis method
In all data analysis, regardless of whether it is within a positi-
vist or naturalistic research tradition, the purpose is to organize
and elicit meaning from the data collected and draw realistic
conclusions (Polit & Beck, 2006). As a method, content analysis is
unique in that it has both a quantitative (Krippendorff, 2004;
Neuendorf, 2002) and a qualitative methodology (Berg, 2001;
Burnard, 1991; Catanzaro, 1988; Downe-Wambolt, 1992), and it
can be used in an inductive or a deductive way. Quantitative
content analysis has its origin in media research, while qualitative
content analysis has its roots originally in social research. Despite
this, none of the forms of content analysis are linked to any par-
ticular science. Consequently, there are no specific conceptions of
meaning, and the concepts used are universal. In quantitative
content analysis, facts from the text are presented in the form of
frequency expressed as a percentage or actual numbers of key
categories (Berelson, 1952; Krippendorff, 2004; Neuendorf, 2002).
This method summarizes rather than reports all details concerning
a message set, and the researcher seeks to answer questions about
how many (Krippendorff, 2004; Neuendorf, 2002). In qualitative
content analysis, data are presented in words and themes, which
makes it possible to draw some interpretation of the results. The
choice of analysis method depends on how deep within the ana-
lysis the researcher attempts to reflect the informants' statements
about a subject. In turn, this affects the number of informants
needed and in the way in which data are to be collected (Burnard,
1991; Polit & Beck, 2006). The researcher has to choose whether
the analysis is to be a manifest analysis or a latent analysis. In a
manifest analysis, the researcher describes what the informants
actually say, stays very close to the text, uses the words them-
selves, and describes the visible and obvious in the text. In
contrast, latent analysis is extended to an interpretive level in
which the researcher seeks to find the underlying meaning of the
text: what the text is talking about (Berg, 2001; Catanzaro, 1988;
Downe-Wambolt, 1992).
Practical implications
During the planning discussion, the researcher must take
ethical aspects into consideration in order to protect the infor-
mants. When the design is established, a presentation of these
aspects is sent to the appropriate ethics committee where
applicable. An information letter to persons involved in the study
must be written, and all participants must be informed orally and/
or in writing about the study before being included. The partici-
pants must be guaranteed confidentiality and informed that par-
ticipation is voluntary and that they can withdraw their data from
the study at any time without it affecting their relationship with
the researchers.
Data collection
Verbal and non-verbal interaction between informants and
researchers shape the data collected, which in turn affects the
results of the study. It is important that the verbal or written
questions are appropriately formulated and adapted to the claims
of the referenced method so that the researcher is able to find
some understanding of the phenomena being studied (Morse &
Richards, 2002). All types of questions related to the aim of the
study can be utilized when content analysis is used. Therefore, the
 M. Bengtsson / NursingPlus Open 2 (2016) 8–14 11

researcher can never be certain that the method of data collection

An experience of loneliness rela-

An experience of loneliness rela-

Theme (Graneheim & Lundman,
provides data that capture the real context of the informants. The

Main-category (Elo & Kyngäs

words used by the informants may not correspond to the
researcher's view of their meaning. Other misrepresentations may

Theme (Burnard, 1991)

Perception of gladness
ted to social isolation

ted to social isolation

arise due to the informants not telling the whole truth, or their
being unable to express themselves, or their being affected by
what they think the researcher wants to hear (Burnard, 1995).
Data collected by interviews, focus groups or other discussions are
often recorded by audio or video. These recordings are usually

2004)

2007)
transcribed into a written form, which is an interpretive process.
Transcriptions sometimes need to be very detailed to capture

Social isolation

Social isolation
speed, tone of voice, emphasis, timing and pauses, but these

Happy feelings
components can be difficult to write down and also analyze. It is

Category
Category

category
Generic-
preferable that the researcher performs the transcribing procedure
(Bailey, 2008).

Data analyzing

Lose touch with

Glad to be alive
Sub-categories

Sub-categories

Needing toilets
Sub-headings
In a review of the literature, different opinions on the use of
concepts, procedures and interpretation in content analysis are pre-

people
sented. However, there are similarities in the way the researchers
explain the process: either they do it by using different distinguish-
ing stages, (Burnard, 1991; Downe-Wambolt, 1992), or in running

Lose touch with

Glad to be alive
text (Berg, 2001; Catanzaro, 1988). The differences lie in the order in

Needing toilets
which the steps of analysis are taken, as well as in the way the
researcher contemplates the data and subsequently conceptualizes.

people
Code
Four main stages have been identified: the decontextualisation, the
recontextualisation, the categorisation, and the compilation (Fig. 1).
However, each stage must be performed several times to maintain

Lose touch with people. Cannot make plans.

the quality and trustworthiness of the analysis. There is no need to

Cannot do what other healthy persons do.

Do not dare go out if there are no toilets

use different main stages for manifest and latent analysis since the
stages of the analyzing process are mainly the same regardless of
An example of an analysis schedule. Transcribed interviews with patients' who have inflammatory bowel diseases.

interpretation (Berg, 2001; Downe-Wambolt, 1992). However, a table

I will never know how I feel.

where the researcher can make transparent the process from raw
Condensed meaning unit

data to results is needed to ensure the quality of the analysis. An

example is given in Table 1. However, in the analyzing process,
human mistakes are always possible; these mistakes can be caused
by fatigue, errors interpretation and personal bias. It is the
researcher's responsibility to maintain the quality of the process by I feel lonely.
assuring validity and reliability throughout the entire study, as the
results must be as rigorous and trustworthy as possible. In a quali-
tative study, validity means that the results truthfully reflect the
phenomena studied, and reliability requires that the same results
Cannot do what other healthy persons do. I lose touch with people. I feel lonely.

a good day. I can never make plans. I do not know how I will feel tomorrow or
When I feel bad I do nothing. I can never be really sure that tomorrow will be

When I need to run to the bath-room 5-6 times in one hour, I do not dare leave

would be obtained if the study were replicated (Morse & Richards,

2002). There is always a risk that different researchers draw dis-
similar conclusions from the same data. To increase the validity, at
home. When I know that there are no toilets I dare not go out.

least two investigators should perform the analysis separately and

then discuss their results and obtain consensus (Burnard, 1991,
Graneheim & Lundman, 2004). This procedure is one form of trian-
gulation. To use different sources or methods for data collection are
other ways to perform triangulations for the purpose of confirming
the results (Catanzaro, 1988; Patton, 2002; Rolfe, 2006).
It could have been worse. I am glad to be alive.

Stage 1 The decontextualisation

The researcher must familiarize him or herself with the data,

and he/she has to read through the transcribed text to obtain the
how I will feel next week.

sense of the whole, that is, to learn “what is going on?”, before it
can be broken down into smaller meaning units. A meaning unit is
the smallest unit that contains some of the insights the researcher
needs, and it is the constellation of sentences or paragraphs con-
Meaning unit

taining aspects related to each other, answering the question set out
in the aim (Catanzaro, 1988; Graneheim & Lundman, 2004). Each
identified meaning unit is labeled with a code, which should be
Table 1

understood in relation to the context. This procedure is recognized

as the “open coding process” in the literature (Berg, 2001). In the
12 M. Bengtsson / NursingPlus Open 2 (2016) 8–14
analyzing process, codes facilitate the identification of concepts
around which the data can be assembled into blocks and patterns
(Catanzaro, 1988). The researcher should use a coding list, including
explanations of the codes, to minimize a cognitive change during
the process of analysis in order to secure reliability (Catanzaro,
1988; Downe-Wambolt, 1992; Morse & Richards, 2002). Codes can
be generated inductively or deductively, depending on the study
design. If the study has a deductive reasoning design, the researcher
has to create a coding list before starting the analyzing process.
Otherwise, the list can be created in the course of the process
(Catanzaro, 1988). Codes created inductively may change as the
study progresses, as more data become available. Interpretations of
the meaning units that seemed clear at the beginning may be
obscured during the process. Therefore, the coding process should
be performed repeatedly, starting on different pages of the text each
time to increase the stability and reliability (Downe-Wambolt,
1992). However, it is much easier to obtain high reliability with
code lists generated deductively rather than inductively (Catanzaro,
1988). There are also computer-programs which can be of help.
Though their use is not imperative, they may facilitate the process.
Although these programs do not analyze the data, they do speed up
the process by, for example, locating codes and grouping data
together in categories. Nevertheless, the researcher must still decide
what constitutes the themes and what conclusions can be drawn
from the results (Flick, 2002; Patton, 2002). Since computer-
programs are soulless software, and human creativity is of impor-
tance and needed, the human being is required.
Stage 2 The recontextualisation
After the meaning units have been identified, the researcher
has then to check whether all aspects of the content have been
covered in relation to the aim (Burnard, 1991). The original text is
re-read alongside the final list of meaning units. Colored pencils
are useful to distinguish each meaning unit in the original tran-
script. After this process has been performed, unmarked text
nearly always remains. The researcher must then consider whe-
ther or not the unmarked text should be included. If the unmarked
text gives some answers to the research question, it should,
therefore, be included in the analysis; otherwise this “dross” can
be excluded (Burnard, 1991, 1995). When the researcher is deeply
involved with the data, everything seems to be of importance.
Nevertheless, a process of distancing is necessary, and the
researcher must allow him or herself to let go of the unimportant
information that does not correspond to the aim of the study.
Stage 3 The categorisation
Before the researcher can begin to create categories, extended
meaning units must be condensed. This entails that the number of
words is reduced without losing content of the unit (Graneheim &
Lundman, 2004). The depth of the meaning units determines the
level at which the analysis can be performed. This process of
condensation is often needed when data are based on interviews
and when latent content analysis is to be carried out. To extract
the sense of the data, the coded material can, as a suggestion, be
divided into domains: broad groups based on different attentions
of the study (Catanzaro, 1988; Patton, 2002). Graneheim and
Lundman (2004) prefer the concept content area, since, in their
view, this elucidates a specific, explicit area. For example, the
material can be divided on the basis of the questions used when
the data were collected or on theoretical assumptions from the
literature.
In the categorization process, themes and categories are identified.
However, in the literature there is no consensus for which headings or
concepts are to be used in a content analysis. Sub-categories, which
Burnard (1991) terms sub-headings, are the smallest units based on
meaning units. In a manifest analysis, sometimes these are the same
as the codes of the meaning units. Sub-categories can be sorted into
broader categories. The concept sub-theme can be used in a latent
analysis instead of the concept categories (Graneheim & Lundman,
2004). Identified themes and categories should be internally homo-
geneous and externally heterogeneous, which means that no data
should fall between two groups nor fit into more than one group
(Krippendorff, 2004; Patton, 2002). Theme is an overall concept of an
underlying meaning on an interpretative latent level, and it answers
the question “How?” (Graneheim & Lundman, 2004). There are no
informal ways to describe specific strategies when categorization is
performed. However, all categories must be rooted in the data from
which they arise. Moving meaning units back and forth between
categories provide progressive development of the category outcome,
and Post-it notes may be of help in this process. Initially, several
categories are often generated, but the number is later reduced (Bur-
nard, 1991). How the researcher knows when the categorization is
good enough depends on the aim of the study, and the categorization
is finished when a reasonable explanation has been reached.
Stage 4 The compilation
Once the categories are established, the analysis and writing up
process begins. One difference between the various qualitative
analyzing methods is how the researcher relates to the analyzing
process itself and adapts to the results. In phenomenological and
hermeneutical- based studies, the researcher focuses on exploring
how the informants make sense of experience and transform
experiences into consciousness. The researcher must then attempt
to find the essence of the studied phenomenon. The researcher has
the opportunity to reach a deeper understanding even if it is on a
descriptive level (Patton, 2002). When performing a qualitative
content analysis, the investigator must consider the data collected
from a neutral perspective and consider their objectivity. However,
the researcher has a choice between the manifest and the latent
level, and the depth of the analysis will depend on how the data
are collected. In a manifest analysis, the researcher works this way
gradually through each identified category and through the
themes in a latent analysis. In a manifest analysis, the researcher
often uses the informants' words, and he/she remains aware of the
need to refer back to the original text. In this way, it is possible to
stay closer to the original meanings and contexts (Burnard, 1991).
In contrast, a latent analysis invites the researcher to immerse
him/herself to some extent in the data in order to identify hidden
meanings in the text. For each category or theme, the researcher
chooses appropriate meaning units presented in the running text
as quotations. Regardless of the form of the analysis, the
researcher can present a summary of themes, categories/sub-
themes and sub-categories/sub-headings as a table to allow the
reader to get a quick overview of the results. In addition, it is
appropriate to present one example of the analysis process. There
is also the possibility to add information by performing some
quantification in which sub-categories and categories are counted.
This is not normally done in other qualitative research methods.
However, nearly everything can be counted in written messages –
such as words, characters, paragraphs and concepts – depending
on the focus of the study. By combining the quantification with a
qualitative approach, the magnitude of the individual phenomena
studied appears more clearly (Berg, 2001; Morgan, 1993). How-
ever, the variables cannot be ranked, since not all informants have
had the opportunity to discuss all the phenomena that the
researcher finally counts.
As a final check, the researcher must consider how the new
findings correspond to the literature and whether or not the result
is reasonable and logical (Burnard, 1991; Morse & Richards, 2002).
 M. Bengtsson / NursingPlus Open 2 (2016) 8–14
To validate the outcome and to strengthen the validity of the
study, the investigator can perform a respondent validation, a
member check, which means that the investigator goes back to the
informants and presents the results in order to achieve agreement
(Burnard, 1991; Catanzaro, 1988) However, there is a time-delay
between the data collection and the analysis. This approach,
therefore, constitutes a risk for various reasons, one of which
might be the possible unreliability of the informants' memory.
Another risk is that informants have a tendency to deny less
attractive aspects of their behavior (Long & Johnson, 2000). In
addition, as the researcher often creates a deeper holistic under-
standing of the studied phenomenon, the informants may not
recognize how the data is presented (Downe-Wambolt, 1992).
Keeping this in mind, it is better for the researcher to obtain some
confirmation on the content from the informants in connection
with the data collection (Catanzaro, 1988). Another way to
increase validity is for a colleague not involved in the study, or an
inquiry auditor, to read the original text and the results and then
judge whether they are reasonable or not (Burnard, 1991;
Catanzaro, 1988; Downe-Wambolt, 1992). However, it is obviously
difficult for an independent person to familiarize him/herself with
another's coding (Morse & Richards, 2002).
A discussion about concepts of trustworthiness
All research must be open to criticism and evaluation. Further,
in the report the study process and the results should be discussed
in relation to concepts linked to trustworthiness. The purpose of
this discussion is to allow the reader to look for alternative
interpretations. There is no consensus on which concepts should
be used nor on how to best judge the quality of research based on
content analysis. The scientists can be divided into two groups:
those who debate the use of the same criteria and concepts as for
quantitative research – validity, reliability and generalizability
(Downe-Wambolt, 1992; Long & Johnson, 2000) – and those who
believe that a different set of criteria and concepts is needed
(Catanzaro, 1988; Graneheim & Lundman, 2004), for example, the
concepts credibility, dependability, transferability and confirmability
created by Lincoln and Guba (1985). Credibility refers to the study
process, that is, to establish how the data and the analysis pro-
cedures are carried out and to ensure that no relevant data have
been excluded. Ways in which credibility can be increased are
through getting agreement from co-investigators, from colleagues,
from an expert panel or from the informants (Graneheim &
Lundman, 2004). Catanzaro (1988) also suggests “negative case
analysis”, which means that the researcher also asks questions to
account for unanticipated answers; however, this can be difficult
and should not be recommended to a novice researcher. That said,
this method is common in self-rated questionnaires to catch the
informants' perspective on health-related issues. The second
concept, dependability, refers to stability, that is, the extent to
which data change over time and the alterations made in the
researcher's decisions during the analyzing procedure. The key
here is to keep track of coding decisions, and the researcher must
use memos to track changes in the development because re-
coding and relabeling are often necessary during the process.
Transferability refers to the degree to which the results may be
applicable to other settings or groups and to the number of
informants or study objects. How representative the sample is will
determine how generalizable the results will be (Krippendorff,
2004). The researcher has often to choose between the breadth
and the depth of the subject being studied. Qualitative studies
often make very limited claims since they mostly focus in depth on
smaller samples, even single cases, which makes a generalization
problematic (Morse & Richards, 2002; Patton 2002; Polit & Beck,
2006). Confirmability is largely an issue of presentation and refers
13
to the objectivity or neutrality of the data (Polit & Beck, 2006). In
general, one can say that credibility corresponds to validity,
dependability to reliability and transferability to generalization. In
any case, the key is not the choice of concept but how the concepts
are discussed in relation to “truth” and “trustworthiness”, since in
qualitative studies there is no definite “truth”. In general, the
researchers are more interested in depth understanding of a spe-
cific issue and in showing different perspectives rather than aim-
ing at singular truth and generalization (Patton, 2002; Rolfe,
2006). Consequently, qualitative studies are also sometimes
impossible and always difficult to replicate because the data arise
from a specific context (Morse & Richards, 2002).
How the researcher handles self-reflection plays a key role in
all qualitative research. For example, in studies based on phe-
nomenological or hermeneutical methodology, the concepts
“bracketing” and “epoche” are used to explain how the investi-
gator should behave in relation to the analyzing procedure. This
approach affects the researcher's interpretation of the informants'
story and the conclusions given in the result (Morse & Richards,
2002; Patton, 2002). In content analysis, the researcher must know
the context, but he/she must also be aware of this knowledge so
that it does not affect neither process nor outcome. Certain
activities in the field remain hidden from the view of the
researcher if he/she is a stranger to the context (Flick, 2002).
Conclusion
Qualitative data – derived from for example, interviews, writ-
ten open questions and pictures – are expressed in words. Con-
sequently, the researcher cannot use statistical analysis to give
meaning to the data and, therefore, needs other methods of ana-
lysis. Content analysis is one such method. This description shows
how the general principles of the method can be used and how the
validity and reliability of the whole process can be increased.
Although there are both advantages and disadvantages to per-
forming a content analysis, it is an easily understood analyzing
process that can be emulated even by those new to the area.
Hopefully, this paper can help others both to give meaning to
textual data and maintain the quality of the analysis.
Coflict of Interest
The author declares that she has no competing interests in
relation to this manuscript and that there are no financial or
financially competing interests to declare.
Funding
Malmö University provided financial support for the conduct of
the research, but had no such involvement in the writing in the
article.
Acknowledgments
I would like to thank Malmö University for funding this project.
References
Bailey, J. (2008). First steps in qualitative data analysis: transcribing. Family Practice,
25, 127–131.
14 M. Bengtsson / NursingPlus Open 2 (2016) 8–14
Bengtsson, M., Ohlsson, B., & Ulander, K. (2007). Women with irritable bowel
syndrome and their perception of a good quality of life. Gastroenterology Nur-
sing, 30(2), 74–82.
Berelson, B. L. (1952). Content analysis in communications research. New York: Free
press.
Berg, B. L. (2001). Qualitative research methods for the social sciences. Boston: Allyn
and Bacon.
Burnard, P. (1991). A method of analysing interview transcripts in qualitative
research. Nurse Education Today, 11, 461–466.
Burnard, P. (1995). Interpreting text: an alternative to some current forms of textual
analysis in qualitative research. Social Sciences in Health, 1, 236–245.
Catanzaro, M. (1988). Using qualitative analytical techniques In: N. F. Woods, &
M. Catanzaro (Eds.), Nursing: research theory and practice (pp. 437–456). St.
Louis: The CV Mosby Company.
Donath, C., Winkler, A., Graessel, E., & Luttenberger, K. (2011). Day care for
dementia patients from a family caregiver's point of view: a questionnaire
study on expected quality and predictors of utilisation – Part II. BMC Health
Services Research, 2011(11), 1–7.
Downe-Wambolt, B. (1992). Content analysis: method, applications and issues.
Health Care for Women International, 13, 313–321.
Eastwood, G. M., O'Connell, B., & Considine, J. (2011). Low-flow oxygen therapy in
intensive care: an observational study. Australian Critical Care, 24, 269–278.
Elo, S., & Kyngäs, H. (2007). The qualitative content analysis process. J Adv Nurs., 62
(1), 107–115.
Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K., & Kyngäs, H. (2014).
Qualitative content analysis: a focus on trustworthiness. SAGE Open, 4.
Flick, U. (2002). An introduction to qualitative research. London: Sage Publications
Inc.
Fridlund, B., & Hildingh, C. (2000). Health and qualitative analysis methods In:
B. Fridlund, & C. Hildingh (Eds.), Qualitative research, methods in the service of
health (pp. 13–25). Lund: Studentlitteratur.
Golsäter, M., Sidenvall, B., Lingfors, H., & Enskär, K. (2011). Adolescents' and school
nurses' perceptions of using a health and lifestyle tool in health dialogues.
Journal of Clinical Nursing, 20, 2573–2583.
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing
research: concepts, procedures and measure to achieve trustworthiness. Nurse
Education Today, 24, 105–112.
Krippendorff, K. (2004). Content analysis: an introduction to its methodology.
Thousand Oaks, California: Sage Publications Inc.
Lincoln, YS. & Guba, EG. (1985). Naturalistic Inquiry. Sage Publications, Newbury
Park, CA.
Long, T., & Johnson, M. (2000). Rigour, reliability and validity in qualitative research.
Clinical Effectiveness in Nursing, 4, 30–37.
Morgan, D. (1993). Qualitative content analysis: a guide to paths not taken. Quali-
tative Health Research, 3, 112–121.
Morse, J. M., & Richards, L. (2002). Read me first for a user's guide to qualitative
methods. Thousand Oaks, California: Sage Publications Inc.
Neuendorf, K. (2002). The content analysis guidebook. Thousand Oaks, California:
Sage Publications Inc.
Patton, M. Q. (2002). Qualitative, research & evaluation methods. Thousand Oaks,
California: Sage publications Inc.
Polit, D. F., & Beck, C. T. (2006). Essentials of nursing research methods, appraisal, and
utilization. Philadelphia, PA: Lippincott Williams & Wilkins.
Rolfe, G. (2006). Validity, trustworthiness and rigour: quality and the idea of qua-
litative research. Journal of Advanced Nursing, 53, 304–310.
Silverman, D. (2001). Interpreting qualitative data methods for analyzing talk, text and
interaction. Thousand Oaks, California: Sage publications Inc.
Wann-Hansson, C., Hallberg, I. R., Klevsgård, R., & Andersson, E. (2005). Patients
´experiences of living with peripheral arterial disease awaiting intervention: a
qualitative study. International Journal of Nursing Studies, 42, 851–862.